Paired risk scores to predict ischaemic and bleeding risk twenty-eight days to one year after an acute coronary syndrome.

OBJECTIVE: The recommended duration of dual anti-platelet therapy (DAPT) following acute coronary syndrome (ACS) varies from 1 month to 1 year depending on the balance of risks of ischaemia and major bleeding. We designed paired ischaemic and major bleeding risk scores to inform this decision. METHODS: New Zealand (NZ) patients with ACS investigated with coronary angiography are recorded in the All NZ ACS Quality Improvement registry and linked to national health datasets. Patients were aged 18-84 years (2012-2020), event free at 28 days postdischarge and without atrial fibrillation. Two 28-day to 1-year postdischarge multivariable risk prediction scores were developed: (1) cardiovascular mortality/rehospitalisation with myocardial infarction or ischaemic stroke (ischaemic score) and (2) bleeding mortality/rehospitalisation with bleeding (bleeding score). FINDINGS: In 27 755 patients, there were 1200 (4.3%) ischaemic and 548 (2.0%) major bleeding events. Both scores were well calibrated with moderate discrimination performance (Harrell's c-statistic 0.75 (95% CI, 0.74 to 0.77) and 0.69 (95% CI, 0.67 to 0 .71), respectively). Applying these scores to the 2020 European Society of Cardiology ACS antithrombotic treatment algorithm, the 31% of the cohort at elevated (>2%) bleeding and ischaemic risk would be considered for an abbreviated DAPT duration. For those at low bleeding risk, but elevated ischaemic risk (37% of the cohort), prolonged DAPT may be appropriate, and for those with low bleeding and ischaemic risk (29% of the cohort) short duration DAPT may be justified. CONCLUSION: We present a pair of ischaemic and bleeding risk scores specifically to assist clinicians and their patients in deciding on DAPT duration beyond the first month post-ACS.

Surveillance, Diversity and Vegetative Compatibility Groups of Fusarium oxysporum f. sp. vasinfectum Collected in Cotton Fields in Australia (2017 to 2022)

Cotton (Gossypium hirsutum) is a billion-dollar crop in regional New South Wales (NSW) and Queensland, Australia. Fusarium wilt (FW) caused by Fusarium oxysporum f. sp. vasinfectum (Fov) is an economically important disease. Initial disease losses of up to 90% when the disease was first detected resulted in fields being taken out of cotton production. The disease is now well-managed due to the adoption of highly resistant varieties. However, annual disease surveys recently revealed that the disease dynamic has changed in the past few seasons. With relatively mild and wet weather conditions during the 2021/22 growing season, FW was detected in eight surveyed valleys in NSW and Queensland, with the disease incidence as high as 44.5% and 98.5% in individual fields in early and late seasons, respectively. Fov is genetically distinct and evolved from local Fusarium oxysporum strains. Additionally, the pathogen was reported to evolve rapidly under continuous cotton cropping pressure. However, our knowledge of the genetic composition of the prevailing population is limited. Sequences of the translation elongation factor alpha 1 (TEF1) revealed that 94% of Fusarium isolates recovered from FW-infected cotton were clustered together with known Australian Fov and relatively distant related to overseas Fov races. All these isolates, except for nine, were further confirmed positive with a specific marker based on the Secreted in Xylem 6 (SIX6) effector gene. Vegetative compatibility group (VCG) analyses of 166 arbitrarily selected isolates revealed a predominance of VCG01111. There was only one detection of VCG01112 in the Border Rivers valley where it was first described. In this study, the exotic Californian Fov race 4 strain was not detected using a specific marker based on the unique Tfo1 insertion in the phosphate (PHO) gene. This study indicated that the prevalence and abundance of Fov across NSW and Queensland in the past five seasons was probably independent of its genetic diversity.

Developing Non-Laboratory Cardiovascular Risk Assessment Charts and Validating Laboratory and Non-Laboratory-Based Models.

Background: Developing simplified risk assessment model based on non-laboratory risk factors that could determine cardiovascular risk as accurately as laboratory-based one can be valuable, particularly in developing countries where there are limited resources. Objective: To develop a simplified non-laboratory cardiovascular disease risk assessment chart based on previously reported laboratory-based chart and evaluate internal and external validation, and recalibration of both risk models to assess the performance of risk scoring tools in other population. Methods: A 10-year non-laboratory-based risk prediction chart was developed for fatal and non-fatal CVD using Cox Proportional Hazard regression. Data from the Isfahan Cohort Study (ICS), a population-based study among 6504 adults aged ≥ 35 years, followed-up for at least ten years was used for the non-laboratory-based model derivation. Participants were followed up until the occurrence of CVD events. Tehran Lipid and Glucose Study (TLGS) data was used to evaluate the external validity of both non-laboratory and laboratory risk assessment models in other populations rather than one used in the model derivation. Results: The discrimination and calibration analysis of the non-laboratory model showed the following values of Harrell's C: 0.73 (95% CI 0.71-0.74), and Nam-D'Agostino χ2:11.01 (p = 0.27), respectively. The non-laboratory model was in agreement and classified high risk and low risk patients as accurately as the laboratory one. Both non-laboratory and laboratory risk prediction models showed good discrimination in the external validation, with Harrell's C of 0.77 (95% CI 0.75-0.78) and 0.78 (95% CI 0.76-0.79), respectively. Conclusions: Our simplified risk assessment model based on non-laboratory risk factors could determine cardiovascular risk as accurately as laboratory-based one. This approach can provide simple risk assessment tool where laboratory testing is unavailable, inconvenient, and costly.

What Factors Predispose Households in Trans-Himalaya (Central Nepal) to Livestock Predation by Snow Leopards?

Livestock depredation across the trans-Himalaya causes significant economic losses to pastoralist communities. Quantification of livestock predation and the assessment of variables associated with depredation are crucial for designing effective long-term mitigation measures. We investigated the patterns and factors of livestock depredation by snow leopards (Panthera uncia) using semi-structured questionnaires targeting herders in the Narphu valley of the Annapurna Conservation Area, Nepal. During the two years (2017/18 and 2018/19), 73.9% of the households interviewed (n = 65) lost livestock to snow leopards, with an annual average loss of two livestock per household. Of the total depredation attributed to snow leopards, 55.4% were yak (mainly female: 79%), 31.7% goat, 6.8% sheep, 3.2% horse and 2.8% cattle. Results from applying Generalized Linear Mixed Models (GLMMs) revealed the total number of livestock owned and the number of larger bodied livestock species as the main explanatory covariates explaining livestock depredation. Forty-one (41%) of all herders considered snow leopard's preference for domestic livestock as the main factor in livestock predation, whereas only 5% perceived poor herding practice as the main reason for the loss. Our study found poor and changing herding practices in the valley, whereby 71% herders reported careful herding as a solution to snow leopard depredation, and 15% of herders considered the complete extermination of snow leopards as the best solution to the problem. Tolerance levels and awareness among herders towards snow leopard conservation is increasing, mainly due to the Buddhist religion and strict law enforcement within this protected area. We recommend the effective implementation of a community-based livestock insurance scheme to compensate the economic loss of herders due to predation and improved herding practices as the recommended mitigation measures for ensuring livestock security and snow leopards' conservation in the valley.

Trends in cardiovascular outcomes after acute coronary syndrome in New Zealand 2006-2016.

OBJECTIVES: Characterisation of trends in acute coronary syndrome (ACS) outcomes are critical to informing clinical practice and quality improvement, but there are few recent population studies for ACS. We reviewed the recent trends in the outcomes of ACS in New Zealand (NZ). METHODS: All patients with ACS admitted to NZ public hospitals in 2006-2016 were identified from hospital discharge records, and their first ACS hospitalisations per year extracted for analysis. Thirty-day and 1-year death, myocardial infarction, stroke, heart failure and bleeding rates were calculated for each calendar year. Trends in outcome rates were assessed using generalised linear mixed models. RESULTS: Total annual ACS hospitalisations decreased from 685 to 424 per 100 000. Using first patient hospitalisations per year (n=1 55 060), we found significant annual declines in all major outcomes except for non-cardiovascular deaths. All-cause mortality fell from 10.5% to 9.1% at 30 days (adjusted OR 0.985 per year change, p<0.001) and from 21.8% to 18.7% at 1 year (OR=0.994, p=0.016). This was related to significant decreases in cardiovascular death at both time points (OR=0.982 and 0.987, respectively, p<0.001), outweighing a slight increase in non-cardiovascular death at 1 year (OR=1.009, p=0.014). One-year rates of myocardial infarction, heart failure, stroke and bleeding rates all decreased significantly over time. CONCLUSION: ACS outcomes including all-cause mortality, cardiovascular death, myocardial infarction, stroke, heart failure and bleeding at 30 days and 1 year improved over the last decade in NZ, reflecting successful implementation and advances in prevention, medical and invasive management in ACS over time.

Co-Occurrence of Defoliating and Non-Defoliating Pathotypes of Verticillium Dahliae in Field-Grown Cotton Plants in New South Wales, Australia.

Verticillium wilt (VW) is a major constraint to cotton production in Australia and worldwide. The disease is caused by a soilborne fungus, Verticillium dahliae, a highly virulent pathogen on cotton. Commonly, V. dahliae is designated into two pathotypes: defoliating (D) and non-defoliating (ND), based on induced symptoms. In the previous two survey seasons between 2017 and 2019, stems with suspected VW were sampled for the confirmation of presence and distribution of D and ND pathotypes across New South Wales (NSW), Australia. A total of 151 and 84 VW-suspected stems sampled from the 2017/18 and 2018/19 seasons, respectively, were subjected to pathogen isolation. Of these, 94 and 57 stems were positive for V. dahliae; and 18 and 20 stems sampled respectively from the two seasons yielded the D pathotype isolates. Two stems from the 2017/18 season and one stem from 2018/19 season yielded both D and ND pathotype isolates. We also successfully demonstrated the co-infection of both pathotypes in pot trials, which was driven predominantly by either of the pathotypes, and appeared independent on vegetative growth, fecundity and spore germination traits. Our study is the first report of the natural co-occurrence of both D and ND pathotypes in same field-grown cotton plants in NSW, to which a challenge to the disease management will be discussed.

Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006-2016.

OBJECTIVES: Recent studies in acute coronary syndrome (ACS) have reported mixed results for trends in ACS subtypes. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) 31 study evaluated trends in ACS event rates, invasive management and mortality of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) in New Zealand. METHODS: All ACS hospitalisations between 2006 and 2016 were identified from routinely collected national data and categorised into STEMI, NSTEMI, UA and MI unspecified (MIU). Annual hospitalisation, coronary procedure, 28-day and 1-year mortality rates were calculated and trends tested using Poisson regression adjusting for age and sex. RESULTS: Over the 11-year study period, there were 188 264 ACS admissions, of which 16.0% were STEMI, 54.5% NSTEMI, 25.7% UA and 3.8% MIU. Event rates of all ACS subtypes fell: STEMI by 3.4%/year, NSTEMI by 5.9%/year and UA by 8.5%/year, while the proportion of patients with ACS receiving angiography and revascularisation increased by 5.6% per year. Rates of percutaneous coronary intervention rose for STEMI, NSTEMI and UA, but coronary artery bypass grafting increased only for NSTEMI and UA. Mortality at 28 days and 1 year was higher for STEMI than NSTEMI and lowest for UA. There was a relative 1.6%/year decline in 1 year mortality for NSTEMI (p<0.001), but no significant change for STEMI and UA. CONCLUSIONS: We observed declines in the event rates of all ACS subtypes and increases in revascularisation rates. The finding that mortality declined in patients with NSTEMI, but not in patients with STEMI and UA, despite increases in invasive procedures, requires further investigation.

Assurance of the existence of a trans-boundary population of the snow leopard (Panthera uncia) at Tsagaanshuvuut - Tsagan-Shibetu SPA at the Mongolia-Russia border.

The existence of a trans-boundary population of the snow leopard (Panthera uncia) that inhabits the massifs of Tsagaanshuvuut (Mongolia) - Tsagan-Shibetu (Russia) was determined through non-invasive genetic analysis of scat samples and by studying the structure of territory use by a collared female individual. The genetic analysis included species identification of samples through sequencing of a fragment of the cytochrome b gene and individual identification using a panel of 8 microsatellites. The home range of a female snow leopard marked with a satellite Global Positioning System (GPS) collar was represented by the minimum convex polygon method (MCP) 100, the MCP 95 method and the fixed kernel 95 method. The results revealed insignificant genetic differentiation between snow leopards that inhabit both massifs (minimal fixation index [FST ]), and the data testify to the unity of the cross-border group. Moreover, 5 common individuals were identified from Mongolian and Russian territories. This finding clearly shows that their home range includes territories of both countries. In addition, regular movement of a collared snow leopard in Mongolia and Russia confirmed the existence of a cross-border snow leopard group. These data support that trans-boundary conservation is important for snow leopards in both countries. We conclude that it is crucial for Russia to study the northern range of snow leopards in Asia.

Longitudinal deprivation trajectories and risk of cardiovascular disease in New Zealand.

We used longitudinal information on area deprivation status to explore the relationship between residential-deprivation mobility and Cardiovascular Disease (CVD). Data from 2,418,397 individuals who were: enrolled in any Primary Health Organisation within New Zealand (NZ) during at least 1 of 34 calendar quarters between 1st January 2006 and 30th June 2014; aged between 30 and 84 years (inclusive) at the start of the study period; had no prior history of CVD; and had recorded address information were analysed. Including a novel trajectory analysis, our findings suggest that movers are healthier than stayers. The deprivation characteristics of the move have a larger impact on the relative risk of CVD for younger movers than for older movers. For older movers any kind of move is associated with a decreased risk of CVD.

Performance of a Framingham cardiovascular risk model among Indians and Europeans in New Zealand and the role of body mass index and social deprivation.

Objectives: To evaluate a Framingham 5-year cardiovascular disease (CVD) risk score in Indians and Europeans in New Zealand, and determine whether body mass index (BMI) and socioeconomic deprivation were independent predictors of CVD risk. Methods: We included Indians and Europeans, aged 30-74 years without prior CVD undergoing risk assessment in New Zealand primary care during 2002-2015 (n=256 446). Risk profiles included standard Framingham predictors (age, sex, systolic blood pressure, total cholesterol/high-density lipoprotein ratio, smoking and diabetes) and were linked with national CVD hospitalisations and mortality datasets. Discrimination was measured by the area under the receiver operating characteristics curve (AUC) and calibration examined graphically. We used Cox regression to study the impact of BMI and deprivation on the risk of CVD with and without adjustment for the Framingham score. Results: During follow-up, 8105 and 1156 CVD events occurred in Europeans and Indians, respectively. Higher AUCs of 0.76 were found in Indian men (95% CI 0.74 to 0.78) and women (95% CI 0.73 to 0.78) compared with 0.74 (95% CI 0.73 to 0.74) in European men and 0.72 (95% CI 0.71 to 0.73) in European women. Framingham was best calibrated in Indian men, and overestimated risk in Indian women and in Europeans. BMI and deprivation were positively associated with CVD, also after adjustment for the Framingham risk score, although the BMI association was attenuated. Conclusions: The Framingham risk model performed reasonably well in Indian men, but overestimated risk in Indian women and in Europeans. BMI and socioeconomic deprivation could be useful predictors in addition to a Framingham score.

Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure: A meta-analysis of individual participant data.

BACKGROUND: Clinical practice guidelines have traditionally recommended blood pressure treatment based primarily on blood pressure thresholds. In contrast, using predicted cardiovascular risk has been advocated as a more effective strategy to guide treatment decisions for cardiovascular disease (CVD) prevention. We aimed to compare outcomes from a blood pressure-lowering treatment strategy based on predicted cardiovascular risk with one based on systolic blood pressure (SBP) level. METHODS AND FINDINGS: We used individual participant data from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) from 1995 to 2013. Trials randomly assigned participants to either blood pressure-lowering drugs versus placebo or more intensive versus less intensive blood pressure-lowering regimens. We estimated 5-y risk of CVD events using a multivariable Weibull model previously developed in this dataset. We compared the two strategies at specific SBP thresholds and across the spectrum of risk and blood pressure levels studied in BPLTTC trials. The primary outcome was number of CVD events avoided per persons treated. We included data from 11 trials (47,872 participants). During a median of 4.0 y of follow-up, 3,566 participants (7.5%) experienced a major cardiovascular event. Areas under the curve comparing the two treatment strategies throughout the range of possible thresholds for CVD risk and SBP demonstrated that, on average, a greater number of CVD events would be avoided for a given number of persons treated with the CVD risk strategy compared with the SBP strategy (area under the curve 0.71 [95% confidence interval (CI) 0.70-0.72] for the CVD risk strategy versus 0.54 [95% CI 0.53-0.55] for the SBP strategy). Compared with treating everyone with SBP ≥ 150 mmHg, a CVD risk strategy would require treatment of 29% (95% CI 26%-31%) fewer persons to prevent the same number of events or would prevent 16% (95% CI 14%-18%) more events for the same number of persons treated. Compared with treating everyone with SBP ≥ 140 mmHg, a CVD risk strategy would require treatment of 3.8% (95% CI 12.5% fewer to 7.2% more) fewer persons to prevent the same number of events or would prevent 3.1% (95% CI 1.5%-5.0%) more events for the same number of persons treated, although the former estimate was not statistically significant. In subgroup analyses, the CVD risk strategy did not appear to be more beneficial than the SBP strategy in patients with diabetes mellitus or established CVD. CONCLUSIONS: A blood pressure-lowering treatment strategy based on predicted cardiovascular risk is more effective than one based on blood pressure levels alone across a range of thresholds. These results support using cardiovascular risk assessment to guide blood pressure treatment decision-making in moderate- to high-risk individuals, particularly for primary prevention.

Range-Wide Snow Leopard Phylogeography Supports Three Subspecies.

The snow leopard, Panthera uncia, is an elusive high-altitude specialist that inhabits vast, inaccessible habitat across Asia. We conducted the first range-wide genetic assessment of snow leopards based on noninvasive scat surveys. Thirty-three microsatellites were genotyped and a total of 683 bp of mitochondrial DNA sequenced in 70 individuals. Snow leopards exhibited low genetic diversity at microsatellites (AN = 5.8, HO = 0.433, HE = 0.568), virtually no mtDNA variation, and underwent a bottleneck in the Holocene (∼8000 years ago) coinciding with increased temperatures, precipitation, and upward treeline shift in the Tibetan Plateau. Multiple analyses supported 3 primary genetic clusters: (1) Northern (the Altai region), (2) Central (core Himalaya and Tibetan Plateau), and (3) Western (Tian Shan, Pamir, trans-Himalaya regions). Accordingly, we recognize 3 subspecies, Panthera uncia irbis (Northern group), Panthera uncia uncia (Western group), and Panthera uncia uncioides (Central group) based upon genetic distinctness, low levels of admixture, unambiguous population assignment, and geographic separation. The patterns of variation were consistent with desert-basin "barrier effects" of the Gobi isolating the northern subspecies (Mongolia), and the trans-Himalaya dividing the central (Qinghai, Tibet, Bhutan, and Nepal) and western subspecies (India, Pakistan, Tajikistan, and Kyrgyzstan). Hierarchical Bayesian clustering analysis revealed additional subdivision into a minimum of 6 proposed management units: western Mongolia, southern Mongolia, Tian Shan, Pamir-Himalaya, Tibet-Himalaya, and Qinghai, with spatial autocorrelation suggesting potential connectivity by dispersing individuals up to ∼400 km. We provide a foundation for global conservation of snow leopard subspecies, and set the stage for in-depth landscape genetics and genomic studies.

Ethnic differences in the prevalence of new and known diabetes mellitus, impaired glucose tolerance, and impaired fasting glucose. Diabetes Heart and Health Survey (DHAH) 2002-2003, Auckland New Zealand.

AIM: To estimate the prevalence of new and known diabetes mellitus, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) by ethnic group in Auckland. METHODS: The Diabetes Heart and Health Survey (DHAH) was a cross-sectional population based survey and was carried out in Auckland between January 2002 and December 2003, inclusive. Participants answered a self-administered questionnaire to assess whether they had previously diagnosed diabetes. Those participants who were not previously diagnosed with diabetes were then given a glucose tolerance test (GTT) to determine diabetes status. RESULTS: Of the total sample 6.7% were previously diagnosed (known) with type 2 diabetes, and a further 2.6% were newly diagnosed. Within the ethnic groups Europeans had the lowest level of both new and known diabetes followed by Maori and then Pacific people (mostly of Samoan, Tongan, Niuean, or Cook Islands origin). The proportions of new/known diabetes by ethnicity were 1.8%/3.9% for Europeans, 3.8%/12.0% for Maori, and 4.0%/19.5% for Pacific. Only Pacific were found to have a significantly greater relative risk (RR) than Europeans of being newly diagnosed with diabetes, particularly in the <45 (RR 11.6), and 45-54 year (RR 4.2) age groups. Compared to Europeans, Maori had a significantly greater risk of known diabetes in the 45-54 (RR 6.4) and 55-64 (RR 4.1) year age groups, while Pacific had a significantly greater risk in all age groups which ranged from RR 2.5 in those aged 65+ to RR 9.3 in the 55-64 year age group. For Europeans and Maori, the greatest proportions of diabetes occurred in the 65+ year age group, however for Pacific this occurred in the 55-64 year age group. IFG levels were only found to be significantly different from Europeans in Maori aged 45-54, and Pacific aged 45-54 and <45 years. IGT levels were only found to be significantly different from Europeans in Pacific aged 45-54 years. CONCLUSIONS: The prevalence of diabetes was 2.8 times greater for Maori, and 4.1 times greater for Pacific compared with Europeans. However for every two European people with previously diagnosed diabetes there was approximately one (0.92) person in the community undiagnosed while for every three Maori people with diagnosed diabetes was one Maori person undiagnosed. For every five Pacific with diagnosed diabetes there was just over one (1.1) Pacific person undiagnosed.

Metabolic syndrome prevalence in a multicultural population in Auckland, New Zealand.

OBJECTIVE: To estimate ethnic-specific metabolic syndrome prevalence in the Auckland region and to identify the main reasons for the differences. METHODS: A cross-sectional survey of adults aged between 35-74 years within the Auckland area using a dual sampling frame with both cluster sampling and random selection from electoral rolls. Participants included 1006 Maori, 996 Pacific people, and 2020 of other ethnicity (mainly Europeans). RESULTS: The prevalence of metabolic syndrome (using the 2001 ATPIII definition, age and gender adjusted) were: Maori 32%, Pacific people 39%, and Others 16%. Maori were twice as likely as others (OR=2.01, 95% CI: 1.53 to 2.64) to have the metabolic syndrome while Pacific people were two and a half times as likely (OR=2.54, 95% CI: 1.93 to 3.35), after adjusting for multiple CVD risk factors other than the components of the syndrome. Adjusting these ethnic differences in prevalences for each of the components of the syndrome separately indicated that most of the differences could be accounted for by differences in obesity. In addition, more than a third of people with diabetes did not have the metabolic syndrome. CONCLUSIONS: The prevalences of metabolic syndrome were significantly higher in Pacific people and Maori compared to Others and measures of obesity accounted for most of the ethnic differences.

Serum lipid levels for a multicultural population in Auckland, New Zealand: results from the Diabetes Heart and Health Survey (DHAH) 2002-2003.

AIMS: To describe mean serum lipid concentrations for Maori, Pacific people (mostly of Samoan, Tongan, Niuean, or Cook Islands origin), and Others (mostly New Zealand-born Europeans), and to identify risk factors for an adverse lipid profile. METHODS: A cross-sectional survey of adults aged between 35-74 years within the Auckland area. There were 1006 Maori, 996 Pacific people, and 2021 'Others' Fasting blood samples were collected from participants, and total cholesterol, high-density lipoproteins (HDL), low-density lipoproteins (LDL), and triglycerides were measured. RESULTS: Maori and Pacific people had similar mean serum total and LDL cholesterol levels but lower HDL levels and higher total to HDL cholesterol ratios compared to Others (adjusted for age and gender). Maori also had higher triglycerides than Others. High BMI and cigarette smoking were positively associated with unfavourable lipid profiles, while current alcohol drinking and vigorous leisure time activity were associated with increased HDL cholesterol and lower total to HDL cholesterol ratios. Over 90% of all ethnic groups had total cholesterol levels above currently accepted optimal levels (>4 mmol/L) and two-thirds were above 5 mmol/L. While 30% of Others had a total to HDL cholesterol ratio above the 'optimal' threshold of 4.5, 40% of Maori and 44% of pacific people were above this level. CONCLUSIONS: This is the first study to simultaneously assess lipid levels in Maori, Pacific people, and Others in one population-based study. Despite similar total and LDL cholesterol levels in all ethnic groups; overweight, obesity, and current cigarette smoking were the main risk factors for their adverse lipid profiles. Engaging in leisure-time activity and alcohol consumption (and not surprisingly lipid-lowering drugs) were associated with better lipid profiles. We confirm that the main lipid-related cardiovascular disease risk in Maori and Pacific people is due to their low HDL and high triglyceride levels.

Differences in health-related socioeconomic characteristics among Pacific populations living in Auckland, New Zealand.

AIM: To describe, compare and contrast the health-related socioeconomic characteristics of the different Pacific ethnic groups surveyed in the Auckland Diabetes, Heart and Health Survey (DHHS). METHODS: The DHHS was carried out in Auckland in 2002-2003. Electoral roll based sampling and cluster sampling strategies were used to recruit a representative sample of Auckland Pacific populations. Participants answered a self-administered questionnaire about their demographic and socioeconomic position. RESULTS: The study surveyed 1011 Pacific people aged between 35-74 years of age. Of the 1011 Pacific participants, 484 were of Samoan, 255 Tongan, 116 Cook Island, 109 Niuean, 26 Fijian, and 21 were of 'Other Pacific' ethnic groups. Samoans were least likely to have no children, and most likely to hold a certificate qualification. Tongans were least likely to be born in New Zealand (NZ) and had the shortest residence time in NZ. Tongans were most likely to be married and had the largest families. Cook Islanders were most likely to be NZ-born and had the highest household income. Niueans were most likely to be in paid employment, to hold a diploma qualification, to own their own homes, and have the smallest families. CONCLUSIONS: In conclusion, a distinct pattern (continuum) emerged from the results. The Cook Island and Niuean ethnic groups generally had a similar and more favourable socioeconomic profile compared to the Samoan and Tongan ethnic groups. These differences are most likely to be related to the length of residence in NZ. As differences existed, each Pacific ethnic group should be investigated separately when there are sufficient numbers.

Beyond hypertension toward guidelines for cardiovascular risk reduction.

BACKGROUND: Most current clinical guidelines focus primarily on the management of individual cardiovascular risk factors, such as high blood pressure (BP), hypercholesterolemia, or diabetes. A more appropriate clinical approach to reducing cardiovascular disease risk would be based on a comprehensive evaluation of risk profile, and accurate stratification of global (absolute) risk in individual patients. We propose that global risk should be used as the main determinant of whom to treat, how to treat, and how much to treat. METHODS: In this article we use a series of case studies to demonstrate the implications of replacing the traditional "single risk factor-based" approach to managing hypertension by one based on global risk assessment. In some situations patients with mildly elevated BP levels would not be recommended for antihypertensive drug treatment whereas others with lower BP would be treated, depending upon the entire risk profile. CONCLUSION: We propose to replace the single risk factor-based approach with the assessment of global cardiovascular risk, both in the clinical management of individual patients and in guidelines.

Alcohol consumption and its contribution to the burden of coronary heart disease in middle-aged and older New Zealanders: a population-based case-control study.

AIMS: To quantify the effect of alcohol consumption on risk of coronary heart disease (CHD) and to estimate the contribution of alcohol to the burden of coronary heart disease mortality and morbidity in New Zealand. METHODS: A population-based case-control study was conducted. Cases were all fatal and major non-fatal coronary events in non-Maori, non-Pacific-Island Auckland residents aged 35-74 years who were identified between 1 January and 31 December 1992 from the Auckland Region Coronary Study. The controls were an age-stratified random sample from the same population. Trained nurse interviewers administered a standard questionnaire to cases (or their next-of-kin) and controls. RESULTS: The study included 1381 cases of acute fatal or non-fatal hospitalised myocardial infarction or coronary heart disease death, and 1892 controls. Compared to non-drinking men, the coronary heart disease risk in men reporting that they regularly drank alcohol more than once per month, was approximately halved. For women, the coronary risk in regular drinkers was approximately one-third lower than in non-drinkers, although the protective association appeared to be stronger among light-to-moderate drinkers. It was estimated that if all non-drinkers and those drinking less than once per month had the same coronary disease risk as regular drinkers, there would be approximately 15% fewer coronary disease events in men and 21% fewer events in women aged 35-74 years in Auckland. Conversely, if regular drinkers had the same risk as non-regular drinkers, there would be 50% more events in men and 16% more events in women. CONCLUSIONS: Middle-aged and older people who regularly drink alcohol (more than once per month) have a significantly lower risk of coronary heart disease than non-drinkers. The magnitude of the attributable risks calculated here suggest that light drinking could have a substantial beneficial effect on coronary disease rates in this age group in New Zealand.